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Transforming Health: Who's affected by Medicaid expansion

Written by Megan Lello | Apr 4, 2013 4:14 AM

(Undated) -- The debate over whether or not Governor Corbett should expand Medicaid in Pennsylvania reached new heights this week when the Republican met with the federal Health and Human Services secretary.  

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Those who could gain coverage, such as 45-year-old Carlos Marrero of Lancaster, are closely watching to see how it all plays out.

Marrero is studying social work at HACC's Lancaster campus. But, besides exams and projects, he's got a lot of other things to worry about: "Being a parent, being a student, being disabled, being on medications, going back and forth to different doctor visits, [and] trying to figure out what's best for my health."

And, Marrero says, it's difficult to figure out just what's best for his health when he doesn't have steady health insurance. He receives a few hundred dollars a month in Social Security disability benefits and used to get partial Medicaid coverage.

But now? "I've contemplated not having surgeries only because of the fact that I can't afford them. Right now, I have three surgeries that I must have, and I will not do them."

Marrero helps support his girlfriend and four children, three of whom have insurance.

He says having insurance himself would spare him from having to make some tough choices. "It's a choice between a doctor's visit, or a week of groceries for my family. It's whether or not I have gas in my car to come to school, to take my daughter to her doctor's appointments. Just to be able to take my family out for a family outing. We want to do the same things that anybody else wants to do, and unfortunately, we can't."

Marrero's just one of the hundreds of thousands of Pennsylvanians who could potentially be affected by a possible Medicaid expansion in the state. Under the Affordable Care Act, states can decide whether or not to expand their programs to those who make up to 138 percent of the federal poverty level. The Kaiser Family Foundation estimates expansion would cover an additional 542,000 Pennsylvanians.

But an Urban Institute and Robert Wood Johnson Foundation report shows if the program isn't expanded, some 400,000 could be left without insurance entirely. That's because they'd earn too much to qualify for Medicaid, but not enough to get subsidies to buy coverage through the federal health insurance marketplace.

Genevieve Kenney is a co-author of the study. She says about half of those people are between the ages of 19 and 34. "They're starting off on their careers. The first jobs they're getting don't necessarily have benefits, or their wages are so low that they can't really afford the coverage that they have available to them."

Nearly 88 percent who'd be left out are adults without dependent children, many of whom don't currently qualify for Medicaid. The program mainly provides for disabled or pregnant adults, or for children through CHIP.

That's why organizations like Families USA, a nonprofit health care group, are pushing for Medicaid expansion.

Governor Corbett has continually balked at the plan, saying it would cost the state too much money. But, he now says after meeting with U.S. Health and Human Services Secretary Kathleen Sebelius, he'd be open to exploring an option that would use federal funds to purchase private insurance plans. Corbett says he's not sure when he'll make a decision about what to do. "If we don’t get it done in the next month or six weeks, maybe it’s two months, maybe it’s three months, maybe it’s into the next year. And maybe we don’t do anything."

Kathleen Stoll, Families USA's deputy executive director, says she understands the governor needs time to make a decision, but she hopes he chooses soon. "For the people who are uninsured and who may be following this debate, it's like being on pins and needles. It's often a matter of life and death to be able to have health insurance in order to access health care."

Marrero in Lancaster says he has some questions for Corbett: "How would he feel if he was in my situation, being a family man? How would he expect to be healthy to be able to take care of his family if he didn't have proper health care?"

A report from the nonpartisan Congressional Budget Office says taxpayers could end up paying more for private insurance than for Medicaid.

 

Learn more about Medicaid expansion through witf's multimedia initiative, Transforming Health

 

 

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